Group Acupuncture Therapy With Yoga Therapy for Chronic Neck, Low Back, and Osteoarthritis Pain in Safety Net Setting for an Underserved Population: Design and Rationale for a Feasibility Pilot

Abstract

Chronic pain is prevalent in the United States, with impact on physical and psychological functioning as well as lost work productivity. Minority and lower socioeconomic populations have increased prevalence of chronic pain with less access to pain care, poorer outcomes, and higher risk of fatal opioid overdose. Acupuncture therapy is effective in treating chronic pain conditions including chronic low back pain, neck pain, shoulder pain, and knee pain from osteoarthritis. Acupuncture therapy, including group acupuncture, is feasible and effective, and specifically so for underserved and diverse populations at risk for health outcome disparities. Acupuncture therapy also encourages patient engagement and activation. As chronic pain improves, there is a natural progression to want and need to increase activity and movement recovery. Diverse movement approaches are important for improving range of motion, maintaining gains, strengthening, and promoting patient engagement and activation. Yoga therapy is an active therapy with proven benefit in musculoskeletal pain disorders and pain associated disability. The aim of this quasi-experimental pilot feasibility trial is to test the bundling of these 2 effective care options for chronic pain, to inform both the design for a larger randomized pragmatic effectiveness trial as well as implementation strategies across underserved settings.

Barriers and Facilitators to Implementing Bundled Acupuncture and Yoga Therapy to Treat Chronic Pain in Community Healthcare Settings: A Feasibility Pilot

“…A detailed plan for our study is described in a previous publication. 41 We used a repeated measures quasi-experimental design in which measurements were taken on participants before (when receiving usual care) and at intervals after treatment was initiated.…”

“…GA sessions were staffed with one acupuncturist who could initiate treatment of up to four participants per hour. 41 The acupuncture therapy intervention, outlined in the manual, 44 consisted of acupuncture needling and a range of other East Asian medicine modalities including Gua Sha, Tui Na, and auricular therapy with needles and/or ear seeds. Acupuncture sessions lasted from 15 to 40 min, with the timing often adapted to facilitate participants starting their YT session.…”

“…[47][48][49][50] A detailed description of dyad YT that was developed for this trial, and the yoga manual, are provided in other publications. 41,51 A full course of treatment consisted of 10 GA treatments and 8 YT sessions.…”

“… 37 , 40 With an aim toward assessing the benefit and implementation issues associated with bundling GA and YT for chronic pain we undertook a feasibility study. 41 YT was used instead of yoga classes because YT is delivered one-on-one or in small groups, includes a thorough client intake, an individualized plan of care, and ongoing assessment of progress. 42 This is much better suited for people with chronic pain and related multimorbidities.…”

Effects of Progressive Relaxation Exercises on Vital Signs and Fatigue in Liver Transplant Patients: A Randomized Controlled Trial

“…In liver transplant patients, it may be beneficial to use low-cost complementary therapies in order to ensure the participation of the individual in their own care and to reduce the symptoms of the disease (Kugler et al, 2009). Studies conducted in Turkey and other countries have shown that people with chronic diseases usually use modern treatment methods alone or in combination with other integrative therapies (Demir & Saritas, 2020; Edwards et al, 2018; Ketai et al, 2021; Nielsen et al, 2020; Rottman et al, 2020). Progressive relaxation exercises, one of these integrative treatment methods, are a type of exercise that involves stretching and relaxation of a large muscle group from hands to feet (Cengiz & Komurkara, 2020).…”